In Kenya, Harm Reduction is Limited by Lack of Social Support
Seed of Hope, a group of people who use drugs in an OST program, using art therapy as a means of developing resilience and talent. Programme funded by the GITOC Resilience Fund.
Apondi makes the case for how drug treatment programmes and the wider health environment for people who use drugs in Kenya are not providing the needed support structure to prevent drug dependency, nor improving the socioeconomic conditions that lead to problematic drug use and criminality in the first place.
The term “harm reduction” refers to policies, programmes and practices that minimise negative health, social and legal outcomes associated with problematic drug use, drug policies and drug laws. Harm reduction is grounded in the principle of justice, and human rights, focusing on positive change and on working with people without judgment, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.
Kenya first embraced harm reduction programming for people who use drugs in 2012, beginning with needle and syringe programmes (NSP) and later including opioid substitution therapy (OST) provision in 2014, as a measure to prevent HIV infections. Since then, the programme has enrolled over 5,200 people who use drugs, primarily in seven counties (Mombasa, Nairobi, Kisumu, Kilifi, Lamu, Kwale and Kiambu) where there are large populations of people using drugs.
Subsequent research and evidence indicate that while there has been a reduction in HIV prevalence among LGBTQ and sex work groups, success has not been replicated for people who inject drugs (PWID). Even though PWID are a key population that is targeted by health programmes, and despite increased enrolments in the OST and NSP sites, HIV rates within this population have remained relatively stable from 2011 to 2021: around 18% of PWID have HIV, compared to an average of almost 6% in the general population. Recent reports also indicate that drug use is increasingly becoming a common denominator across all key populations that health programmes in the country target. This has brought into focus the importance of behavioural and community interventions which play a big role in the management and treatment of drug use, but has not fully been embraced due to scarcity of resources.
Implementation of harm reduction programmes in African countries face various challenges, of which a considerable one is the absence of a fully funded mental health component that intersect with drug-related concerns. Harm reduction programmes in Kenya are not anchored in law: Kenyan drug policies are still produced by the Ministry of Interior, which employs devolved organisations such as anti-narcotics bodies and the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) to mandate on drug education, regulate the operation of rehabilitation facilities, and formulate national drug policies.
The lack of harm reduction legislation in the country means that there is effectively a de-prioritisation of these programmes in domestic budgets, and the perpetuation of a criminalised environment that polices, stigmatises and discriminates against people who use drugs. Treatment services are thus shaped by legal, political, cultural and economic factors that focus on the biomedical treatment of patients, rather than addressing the behavioural factors that led to problematic relationships with drugs in the first place.
The focus on biomedical indicators (such as HIV prevalence rates) means that most responses to drug issues in Kenya have been focused solely on reducing their prevalence, missing the wider picture. There are no harm reduction programmes in place in Kenya outside of HIV prevention, nor any additional programmes to support OST provision and reinsertion of people into society after drug treatment.
The persistent lack of social and behavioural change-oriented programmes has meant that the social and economic issues that impact people who use or have used drugs are not addressed. People struggle to find employment after treatment, or still face stigma due to their history of drug use. This in turn reinforces and accelerates existing socio-economic difficulties linked with poverty, crime, lack of education, unplanned parenthood, incarceration and detainment, among others. It creates an unending cycle of dependence on petty crime as a means to survival. Despite the best intentions of OST programmes, the lack of social and economic support means this cycle is unlikely to be interrupted.
Africa has a big population of youth unemployment, which in turn increases the attractiveness of drug use. With unending corruption and highly porous borders, more drugs have increasingly found their way into the continent. Increasingly there are concerns about a drug epidemic among African youth in the coming years, with few solutions present if nothing fundamentally alters.
Harm reduction programming must be developed based on the reality of the lives of people who use drugs. A renewed focus is needed on community-based interventions as a form of continuity into recovery, with more emphasis in resilience and cognitive skills. Education on drug and alcohol dependence, common triggers and how to manage cravings is also needed at an earlier stage as prevention strategies, to respond to environmental factors like youth unemployment and drug use in social circles. Treatment centres and health services must be proactive by maintaining regular contact with their clients, involving family and friends as part of their treatment, addressing multiple drug use and mental health problems, and facilitating vocational training and employment.
VOCAL-KENYA is using its civil society role to lead on work with Parliamentary committees and government departments, advocating for a move away from punitive drug policies, and instead move towards a focus on human rights and public health. VOCAL is also working on the introduction of a model harm reduction Bill in 2022, which will introduce domestic funding for drug use treatment. VOCAL also partners with law enforcement officers to introduce diversion schemes and community sentencing, which is aimed at reducing the number of low-level drug offenders having extended sentences in prison, while also partnering with international organisations to conduct research on current trends in drug use, that can then inform policy.
*Bernice Apondi has been working with communities of people who use drugs and policy makers in East Africa for the past 10 years. Her area of focus has been: shifting the paradigm and putting public health, community safety, human rights and development at the center of the region's drug laws and policy. Currently Bernice is the a Consultant for research and advocacy and VOCAL-KENYA.